Title VIII Reauthorization Statutory Language Changes

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1 Section 801: Definitions 1 Current Authority Recommendation Rationale Amend the Definition of School of Nursing Section 296(2) (2) School of nursing The term school of nursing means a collegiate, associate degree, or diploma school of nursing in a State. Amend 296(2) by including: (2) School of nursing The term school of nursing means an accredited, as defined by subsection 6 of this section, collegiate, associate degree, or diploma school of nursing, in a State where graduates are: (a) authorized to sit for the National Council Licensure EXamination- Registered Nurse (NCLEX-RN ); or (b) Licensed Registered Nurses who will receive a graduate or equivalent degree or training to become an advanced education nurse as defined by section 296(j)(b) [or section 811(b) of the Public Law ] of this title. This amendment clarifies that the grant funding to schools of nursing should be provided to those graduating students prepared to take the National Council Licensure EXamination- Registered Nurse or Registered Nurses obtaining a graduate degree or training in advanced nursing content. Registered Nurses, including those with advanced education, are in the greatest demand and the funding for these programs should be refined to those categories. 1

2 Section 801: Definitions Title VIII Reauthorization 2 Current Authority Recommendation Rationale Include Nurse-Managed Health Clinics as a Definition Section 296 Add to Section 296 a subsection (16) (16) Nurse-Managed Health Clinics.- Nurse-managed Health Clinic means a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and is associated with a school, college, university or department of nursing, federally qualified health center, or independent non-profit health or social services agency. The nurse-managed care model is recognized as a key to efficient, sensible, cost-effective primary health care. NMHCs are especially effective in providing individualized primary care that includes health promotion, disease prevention and early detection, health teaching, management of chronic conditions, treatment of acute illnesses, and counseling. Research has documented that patient satisfaction with care is very high, the management of patients with chronic illnesses is especially comprehensive and effective, and NMHCs are successful in increasing access to care for at-risk populations and managing their care. NMHCs traditionally focus on populations underserved by the larger health care system. In partnership with schools of nursing, NMHCs are exciting learning environments for nurses of all levels that provide: (1) opportunities for innovative practice development; (2) sites for faculty practice and research, student education and research, and community service; and (3) a source for diverse learning experiences. NMHCs, on average, currently provide clinical education experiences to 42 students per site per academic year. 2

3 Section 811: Advanced Education Nursing Grants 3 Current Authority Recommendation Rationale Removal of 10% Cap Section 296j(f)(2), The Secretary may not obligate more than 10 percent of the traineeships under subsection (a) of this section for individuals in doctorate degree programs. Strike section 296j(f)(2) By increasing the amount of advanced education traineeship funding given to doctoral students, the potential for additional nurse faculty increases. Moreover, this revision will directly impact the practice and faculty shortage by assisting students who wish to obtain their degree to pursue a teaching, research, or advanced clinical practice career. 3

4 Section 811: Advanced Education Nursing Grants 4 Current Authority Recommendation Rationale Strengthen Nurse Midwife Language (c) Authorized nurse practitioner and nurse midwifery programs Nurse practitioner and nurse midwifery programs eligible for support under this section are educational programs for registered nurses (irrespective of the type of school of nursing in which the nurses received their training) that (1) meet guidelines prescribed by the Secretary; and (2) have as their objective the education of nurses who will upon completion of their studies in such programs, be qualified to effectively provide primary health care, including primary health care in homes and in ambulatory care facilities, longterm care facilities, acute care, and other health care settings. (d) Authorized nurse anesthesia programs Nurse anesthesia programs eligible for support under this Strike nurse midwifery from section 296j(c) and add section 296j(d) Strike section 296j(f)(2) (c) Authorized nurse practitioner and nurse midwifery programs Nurse practitioner and nurse midwifery programs eligible for support under this section are educational programs for registered nurses (irrespective of the type of school of nursing in which the nurses received their training) that (1) meet guidelines prescribed by the Secretary; and (2) have as their objective the education of nurses who will upon completion of their studies in such programs, be qualified to effectively provide primary health care, including primary health care in homes and in ambulatory care facilities, long-term care facilities, acute care, and other health care settings. (d) Authorized nurse-midwifery programs Midwifery programs eligible for support under this section are educational programs that - (1) have as their objective the education of midwives, who will upon completion of their studies in such programs, be qualified The Nursing Community believes there is a need to describe in greater detail the statutory purpose of grants through the AEN program as they relate to midwifery care. This will help both the educational program and HRSA in supporting those grant requests that target the educational needs of student midwives across the spectrum of settings in which midwives practice today. 4

5 section are education programs that (1) provide registered nurses with full-time anesthetist education; and (2) are accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. (e) Other authorized educational programs The Secretary shall prescribe guidelines as appropriate for other advanced nurse education programs eligible for support under this section. (f) Traineeships (1) In general The Secretary may not award a grant to an applicant under subsection (a) of this section unless the applicant involved agrees that traineeships provided with the grant will only pay all or part of the costs of (A) the tuition, books, and fees of the program of advanced nurse education with respect to which the traineeship is provided; and (B) the reasonable living expenses of the individual during the period for which the traineeship is provided. (2) Doctoral programs to effectively provide primary health care services to women at locations where women might require health care services, including acute care facilities, ambulatory care facilities, birth centers, personal residences, and other settings as authorized by state or federal law; and (2) are accredited by the American College of Nurse-Midwives Accreditation Commission for Midwifery Education. (d e) Authorized nurse anesthesia programs Nurse anesthesia programs eligible for support under this section are education programs that (1) provide registered nurses with full-time anesthetist education; and (2) are accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. (e f) Other authorized educational programs The Secretary shall prescribe guidelines as appropriate for other advanced nurse education programs eligible for support under this section. (f g) Traineeships (1) In general The Secretary may not award a grant to an applicant under subsection (a) of this section unless the applicant involved agrees that traineeships provided with the grant will only pay all or part of the costs of (A) the tuition, books, and fees of the program of advanced nurse education with respect to which the traineeship is provided; and 5

6 The Secretary may not obligate more than 10 percent of the traineeships under subsection (a) of this section for individuals in doctorate degree programs. (3) Special consideration In making awards of grants and contracts under subsection (a)(2) of this section, the Secretary shall give special consideration to an eligible entity that agrees to expend the award to train advanced education nurses who will practice in health professional shortage areas designated under section 254e of this title. (B) the reasonable living expenses of the individual during the period for which the traineeship is provided. (2) Doctoral programs The Secretary may not obligate more than 10 percent of the traineeships under subsection (a) of this section for individuals in doctorate degree programs. (23) Special consideration In making awards of grants and contracts under subsection (a)(2) of this section, the Secretary shall give special consideration to an eligible entity that agrees to expend the award to train advanced education nurses who will practice in health professional shortage areas designated under section 254e of this title. 6

7 Section 821: Workforce Diversity Grants 5 Current Authority Recommendation Rationale Include bridge programs and accelerate degree programs Section 296m (a) In general The Secretary may award grants to and enter into contracts with eligible entities to meet the costs of special projects to increase nursing education opportunities for individuals who are from disadvantaged backgrounds (including racial and ethnic minorities underrepresented among registered nurses) by providing student scholarships or stipends, pre-entry preparation, and retention activities. Section 296m (a) In general The Secretary may award grants to and enter into contracts with eligible entities to meet the costs of special projects to increase nursing education opportunities for individuals who are from disadvantaged backgrounds (including racial and ethnic minorities underrepresented among registered nurses) by providing student scholarships or stipends, scholarships or stipends for diploma or associate degree nurses to enter a bridge or degree completion program, student scholarships or stipends for accelerated nursing degree programs, pre-entry preparation, advanced education preparation, and retention activities. (1) for the purposes of this section, a bridge or degree completion program means a program of education in professional nursing offered by an accredited school of nursing, as defined by section 296(2) [section 801(2) of the Public Law ] of this title, that leads to a baccalaureate degree in To facilitate a better educated workforce, degree completion programs provide additional education to registered nurses who received their initial nursing preparation in diploma and associate degree programs. These bridge programs build on previous learning, prepare nurses for a higher level of nursing practice, and provide RNs with the education necessary to move forward in their nursing careers. Currently, 139 LPN to RN programs and 621 RN to BSN programs are available nationwide. Program length varies between 1 to 2 years depending upon the school's requirements, program type and the student's previous academic achievement. Enrollment in RN to BSN programs is increasing in response to calls for a more 7

8 nursing. These programs may include, Registered Nurse (RN) to Bachelor s of Science of Nursing (BSN) program; RN to MSN (Master of Science of Nursing) program, or BSN to Doctoral program. (2) For the purposes of this section, the term accelerated nursing degree program means a program of education in professional nursing offered by an accredited school of nursing, as defined by section 296(2) [section 801(2) of the Public Law ] of this title, in which an individual holding a bachelors degree in another discipline receives a BSN or MSN degree in an accelerated time frame as determined by the accredited school of nursing. highly educated nursing workforce. From 2007 to 2008, enrollments increased by 8.2 percent or by 4,105 students, marking the fifth consecutive year of increases in RN to BSN programs. With the Bureau of Labor Statistics projecting the need for more than a million new and replacement registered nurses by the year 2016, nursing schools around the country are exploring creative ways to increase student capacity and reach out to new student populations. The challenge inherent in these efforts is to quickly produce competent nurses while maintaining the integrity and quality of the nursing education provided. Though not new to nursing education, accelerated programs have proliferated over the past fifteen years. In 1990, 31 accelerated BSN programs and 12 generic master's programs were offered around the country. Today, 205 accelerated BSN programs are operating and the number of generic master's programs has increased to 56. 8

9 Section 821: Workforce Diversity Grants 6 Current Authority Recommendation Rationale Eliminate Outdated Language and Include the Other Minority Nursing Organizations. (b) Guidance In carrying out subsection (a) of this section, the Secretary shall take into consideration the recommendations of the First, Second and Third Invitational Congresses for Minority Nurse Leaders on Caring for the Emerging Majority, in 1992, 1993 and 1997, and consult with nursing associations including the American Nurses Association, the National League for Nursing, the American Association of Colleges of Nursing, the National Black Nurses Association, the National Association of Hispanic Nurses, the Association of Asian American and Pacific Islander Nurses, the Native American Indian and Alaskan Nurses Association, and the National Council of State Boards of Nursing. (b) Guidance In carrying out subsection (a) of this section, the Secretary shall take into consideration the recommendations of the First, Second and Third Invitational Congresses for Minority Nurse Leaders on Caring for the Emerging Majority, in 1992, 1993 and 1997, and National Advisory Council on Nurse Education and Practice and consult with nursing associations including the, National Coalition of Ethnic Minority Nurse Associations, American Nurses Association, the National League for Nursing, the American Association of Colleges of Nursing, the National Black Nurses Association, the National Association of Hispanic Nurses, the Association of Asian American and Pacific Islander Nurses, the Native American Indian and Alaskan Nurses Association, and the National Council of State Boards of Nursing and other organizations deemed appropriate by the Secretary. These Invitational Congresses are no longer held, and the National Advisory Council on Nurse Education and Practice serves as a body to make recommendations to Congress. The National Coalition of Ethnic Minority Nurse Associations and other organizations deemed appropriate by the Secretary was added to provide a broad base of expertise. 9

10 Section 831: Nurse Education, Practice, and Retention Grants 7 Current Authority Recommendation Rationale Separate the Retention Grant Section Include language for ADN and Diploma nurses to benefit from the Career Ladder Program Section 296(p)(c) Retention priority areas The Secretary may award grants to and enter into contracts with eligible entities to enhance the nursing workforce by initiating and maintaining nurse retention programs pursuant to paragraph (1) or (2). (1) Grants for career ladder programs The Secretary may award grants to and enter into contracts with eligible entities for programs (A) to promote career advancement for nursing personnel in a variety of training settings, cross training or specialty training among diverse population groups, and the advancement of individuals including to become professional nurses, advanced education nurses, licensed practical nurses, certified nurse assistants, and home health aides; and (B) to assist individuals in obtaining education and training required to enter the nursing profession and advance within such profession, such as by providing career counseling and mentoring. (2) Enhancing patient care delivery systems 1. Delete Section 296(p)(c) and 296(p)(a)(2) from Section 831 and create Section 831A Nurse Retention Grants 2. The new Section 831A Nurse Retention Grants will read: (a) Retention priority areas The Secretary may award grants to and enter into contracts with eligible entities to enhance the nursing workforce by initiating and maintaining nurse retention programs pursuant to paragraph (1) or (2). (1) Grants for career ladder programs The Secretary may award grants to and enter into contracts with eligible entities for programs (A) to promote career advancement for nursing personnel in a variety of training settings, cross training or specialty training among diverse population groups, and the advancement of individuals including to become professional nurses, advanced education nurses, licensed practical nurses, certified nurse assistants, and home health aides; and individuals including licensed Due to the current retention problems within the nursing profession, which spans both ends of the experience spectrum, a separate Title VIII section should be created to retain our experienced and new nurses. This section should be titled Nurse Retention Grants and be aligned with Section 831 as Section 831A. By delineating the retention aspect of this program, a specific funding stream would be created to ensure proper consideration is given to retaining nurses and would address the unique barriers associated with retention. 10

11 (A) Grants The Secretary may award grants to eligible entities to improve the retention of nurses and enhance patient care that is directly related to nursing activities by enhancing collaboration and communication among nurses and other health care professionals, and by promoting nurse involvement in the organizational and clinical decision-making processes of a health care facility. practical nurses, licensed vocational nurses, certified nurse assistants, home health aides, diploma degree or associate degree nurses, to become baccalaureate prepared professional registered nurses or advanced education nurses in order to meet the needs of the registered nurse workforce. (B) developing and implementing internships and residency programs in collaboration with an accredited school of nursing, as defined by section 296(2) [section 801(2) of the Public Law ] of this title, to encourage mentoring and the development of specialties; or (C) to assist individuals in obtaining education and training required to enter the nursing profession and advance within such profession, such as by providing career counseling and mentoring. (2) Enhancing patient care delivery systems (A) Grants The Secretary may award grants to eligible entities to improve the retention of nurses and enhance patient care that is directly related to nursing activities by enhancing collaboration and communication among nurses and other By including in collaboration with an accredited school of nursing, nurse internships and residencies will help foster stronger partnerships between the schools of nursing and practice settings. 11

12 health care professionals, and by promoting nurse involvement in the organizational and clinical decisionmaking processes of a health care facility. (B) Preference In making awards of grants under this paragraph, the Secretary shall give a preference to applicants that have not previously received an award under this paragraph. (C) Continuation of an award The Secretary shall make continuation of any award under this paragraph beyond the second year of such award contingent on the recipient of such award having demonstrated to the Secretary measurable and substantive improvement in nurse retention or patient care. (b) Other priority areas The Secretary may award grants to or enter into contracts with eligible entities to address other areas that are of high priority to nurse retention, as determined by the Secretary. (c) Report The Secretary shall submit to the Congress before the end of each fiscal year a report on the grants awarded and the contracts entered into under this section. Each such report shall identify the overall number of such grants and contracts and provide an explanation of 12

13 why each such grant or contract will meet the priority need of the nursing workforce. (d) Eligible entity For purposes of this section, the term eligible entity includes an accredited school of nursing, as defined by section 296(2) [section 801(2) of the Public Law ] of this title, a health care facility, or a partnership of such a school and facility. (e) Authorization of appropriations There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2009 through

14 Section 831: Nurse, Education, Retention, and Quality 8 Current Authority Recommendation Rationale Creation of the Nurse Education, Practice, and Quality Program (a) Education priority areas The Secretary may award grants to or enter into contracts with eligible entities for (1) expanding the enrollment in baccalaureate nursing programs; (2) developing and implementing internship and residency programs to encourage mentoring and the development of specialties; or (3) providing education in new technologies, including distance learning methodologies. (b) Practice priority areas The Secretary may award grants to or enter into contracts with eligible entities for (1) establishing or expanding nursing practice arrangements in noninstitutional settings to demonstrate methods to improve access to primary health care in medically underserved communities; (2) providing care for underserved populations and other high-risk groups such as the elderly, individuals with HIV/AIDS, substance abusers, the homeless, and victims of domestic violence; (3) providing managed care, quality Rename Section 831 to Nurse Education, Practice, and Quality Grants. (a) Education priority areas The Secretary may award grants to or enter into contracts with eligible entities for (1) expanding the enrollment in baccalaureate nursing programs; (2) developing and implementing internship and residency programs to encourage mentoring and the development of specialties; or (3 2) providing education in new technologies, including distance learning methodologies. (b) Practice priority areas The Secretary may award grants to or enter into contracts with eligible entities for (1) establishing or expanding nursing practice arrangements in noninstitutional settings to demonstrate methods to improve access to primary health care in medically underserved communities; (2) providing care for underserved populations and other high-risk groups such as the elderly, individuals with 14

15 improvement, and other skills needed to practice in existing and emerging organized health care systems; or (4) developing cultural competencies among nurses. (c) Retention priority areas The Secretary may award grants to and enter into contracts with eligible entities to enhance the nursing workforce by initiating and maintaining nurse retention programs pursuant to paragraph (1) or (2). (1) Grants for career ladder programs The Secretary may award grants to and enter into contracts with eligible entities for programs (A) to promote career advancement for nursing personnel in a variety of training settings, cross training or specialty training among diverse population groups, and the advancement of individuals including to become professional nurses, advanced education nurses, licensed practical nurses, certified nurse assistants, and home health aides; and (B) to assist individuals in obtaining education and training required to enter the nursing profession and advance within such profession, such as by providing career counseling and mentoring. (2) Enhancing patient care delivery systems HIV/AIDS, substance abusers, the homeless, and victims of domestic violence; (3) providing coordinated managed care, quality improvement, and other skills needed to practice in existing and emerging organized health care systems; or (4) developing cultural competencies among nurses. (c) Quality priority areas The Secretary in collaboration with the Administrator of the Health Resources and Services Administration and the Director of the Agency for Healthcare Research and Quality may award grants or enter into contracts with eligible entities to carry out demonstration projects for (1) establishing or expanding partnerships between eligible entities to incorporate the Quality and Safety for Nursing Education (QSEN) Competencies, patientcentered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics, into nursing practice and education; or (2) establishing or expanding strategies to improve clinical Professional nurses play a critical role in protecting patient safety and providing quality health care. In fact, an expert committee formed by the Institute of Medicine (IOM) found that "how we are cared for by nurses affects our health, and sometimes can be a matter of life and death nurses are indispensable to our safety" (IOM, 2004). This finding has been confirmed by an emerging body of research showing that nurses are much more likely than any other health professional to recognize, interrupt and correct errors that are often life threatening (Rothschild et al., 2006), and that inadequate nurse staffing levels may lead to a higher incidence of complications and inadequate care (Aiken et al., 2002, JCAHO, 2002; Needleman et al., 2002). Calls to address patient safety issues are growing louder and must be addressed by all health disciplines, 15

16 (A) Grants The Secretary may award grants to eligible entities to improve the retention of nurses and enhance patient care that is directly related to nursing activities by enhancing collaboration and communication among nurses and other health care professionals, and by promoting nurse involvement in the organizational and clinical decisionmaking processes of a health care facility. (B) Preference In making awards of grants under this paragraph, the Secretary shall give a preference to applicants that have not previously received an award under this paragraph. (C) Continuation of an award The Secretary shall make continuation of any award under this paragraph beyond the second year of such award contingent on the recipient of such award having demonstrated to the Secretary measurable and substantive improvement in nurse retention or patient care. (d) Other priority areas The Secretary may award grants to or enter into contracts with eligible entities to address other areas that are of high priority to nurse education, practice, and retention, as determined by the Secretary. (e) Preference Title VIII Reauthorization (d) Preference leadership; interdisciplinary team management; outcomes and risk management; and economic value of nursing. In making awards of grants under this paragraph, the Secretary shall give a preference to applicants that have not previously received an award under this paragraph. (e) Continuation of an award The Secretary shall make continuation of any award under this paragraph beyond the second year of such award contingent on the recipient of such award having demonstrated to the Secretary measurable and substantive improvement in nurse retention or patient care. (f) Other priority areas The Secretary may award grants to or enter into contracts with eligible entities to address other areas that are of high priority to nurse education, practice, and retention, as determined by the Secretary. enter into contracts with eligible entities to address other areas that are of high priority to nurse education, practice, and quality (g) Report The Secretary shall submit to the Congress before the end of each fiscal including nursing. Therefore, the Nursing Community recommends that a quality section be added so that nurses can continue to expand their quality expertise for the safety of the patient. 16

17 For purposes of any amount of funds appropriated to carry out this section for fiscal year 2003, 2004, or 2005 that is in excess of the amount of funds appropriated to carry out this section for fiscal year 2002, the Secretary shall give preference to awarding grants or entering into contracts under subsections (a)(2) and (c) of this section. (f) Report The Secretary shall submit to the Congress before the end of each fiscal year a report on the grants awarded and the contracts entered into under this section. Each such report shall identify the overall number of such grants and contracts and provide an explanation of why each such grant or contract will meet the priority need of the nursing workforce. (g) Eligible entity For purposes of this section, the term eligible entity includes a school of nursing, a health care facility, or a partnership of such a school and facility. (h) Authorization of appropriations There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2003 through year a report on the grants awarded and the contracts entered into under this section. Each such report shall identify the overall number of such grants and contracts and provide an explanation of why each such grant or contract will meet the priority need of the nursing workforce. (h) Eligible entity For purposes of this section, the term eligible entity includes a school of nursing as defined by section 296(2) [section 801(2) of the Public Law ] of this title, a health care facility, or a partnership of such a school and facility. (i) Authorization of appropriations There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years through

18 Section : Nursing Student Loan Program 9 Current Authority Recommendation Rationale Update Current Funding Levels Section 297b(a), The total of the loans for any academic year (or its equivalent, as determined under regulations of the Secretary) made by schools of nursing from loan funds established pursuant to agreements under this part may not exceed $2,500 in the case of any student, except that for the final two academic years of the program involved, such total may not exceed $4,000. The aggregate of the loans for all years from such funds may not exceed $13,000 in the case of any student. Section 297b(a), The total of the loans for any academic year (or its equivalent, as determined under regulations of the Secretary) made by schools of nursing from loan funds established pursuant to agreements under this part may not exceed $2,500 $3,300 in the case of any student, except that for the final two academic years of the program involved, such total may not exceed $4,000 $5,200. The aggregate of the loans for all years from such funds may not exceed $13,000 $17,000 in the case of any student during the 2010 and 2011 fiscal years. After fiscal year 2011, cost-of-living adjustments will be enacted for the yearly loan rate and the aggregate loan. Section 296(b)(a) was last amended in 1998 and reflects funding levels appropriate for that year. The funding levels should be amended to adjust for the 11 year inflation difference. 18

19 Section : Nursing Student Loan Program 10 Current Authority Recommendation Rationale Updating years Section 297b (b) Terms and conditions Loans from any such student loan fund by any school shall be made on such terms and conditions as the school may determine; subject, however, to such conditions, limitations, and requirements as the Secretary may prescribe (by regulation or in the agreement with the school) with a view to preventing impairment of the capital of such fund to the maximum extent practicable in the light of the objective of enabling the student to complete his course of study; and except that (1) such a loan may be made only to a student who (A) is in need of the amount of the loan to pursue a full-time or half-time course of study at the school leading to a baccalaureate or associate degree in nursing or an equivalent degree, or a diploma in nursing, or a graduate degree in nursing, (B) is capable, in the opinion of the school, of maintaining good standing in such course of study, and (C) with respect to any student enrolling in the school after June 30, 1986, is of financial need (as defined in regulations issued by the Secretary);; Section 297b (b) Terms and conditions Loans from any such student loan fund by any school shall be made on such terms and conditions as the school may determine; subject, however, to such conditions, limitations, and requirements as the Secretary may prescribe (by regulation or in the agreement with the school) with a view to preventing impairment of the capital of such fund to the maximum extent practicable in the light of the objective of enabling the student to complete his course of study; and except that (1) such a loan may be made only to a student who (A) is in need of the amount of the loan to pursue a full-time or half-time course of study at the school leading to a baccalaureate or associate degree in nursing or an equivalent degree, or a diploma in nursing, or a graduate degree in nursing, (B) is capable, in the opinion of the school, of maintaining good standing in such course of study, and (C) with respect to any student enrolling in the school after June 30, , is of financial need (as defined in regulations issued by the Secretary);; Update 19

20 Section : Nursing Student Loan Program 11 Current Authority Recommendation Rationale Update Section 297b 3) in the case of a student who received such a loan before September 29, 1979, an amount up to 85 per centum of any such loan made before such date (plus interest thereon) shall be canceled for full-time employment as a professional nurse (including teaching in any of the fields of nurse training and service as an administrator, supervisor, or consultant in any of the fields of nursing) in any public or nonprofit private agency, institution, or organization (including neighborhood health centers), at the rate of 15 per centum of the amount of such loan (plus interest) unpaid on the first day of such service for each of the first, second, and third complete year of such service, and 20 per centum of such amount (plus interest) for each complete fourth and fifth year of such service; Section 297b (3) in the case of a student who received such a loan before September 29, , an amount up to 85 per centum of any such loan made before such date (plus interest thereon) shall be canceled for full-time employment as a professional nurse (including teaching in any of the fields of nurse training and service as an administrator, supervisor, or consultant in any of the fields of nursing) in any public or nonprofit private agency, institution, or organization (including neighborhood health centers), at the rate of 15 per centum of the amount of such loan (plus interest) unpaid on the first day of such service for each of the first, second, and third complete year of such service, and 20 per centum of such amount (plus interest) for each complete fourth and fifth year of such service; Update 20

21 Section 841: Authorization of Appropriations 12 Current Authority Recommendation Rationale Increase Appropriations to include the NEED Act and the President Obama s FY 2010 Budget Proposal Repeal the funding methodology Section 297q (a) Authorization of appropriations For the purpose of carrying out parts B, C, and D of this subchapter (subject to section 297t (g) of this title), there are authorized to be appropriated $65,000,000 for fiscal year 1998, and such sums as may be necessary for each of the fiscal years 1999 through (b) Allocations for fiscal years 1998 through 2002 (1) Nurse practitioners; nurse midwives (A) Fiscal year 1998 Of the amount appropriated under subsection (a) of this section for fiscal year 1998, the Secretary shall reserve not less than $17,564,000 for making awards of grants and contracts under section 296m of this title as such section was in effect for fiscal year (B) Fiscal years 1999 through 2002 Of the amount appropriated under subsection (a) of this section for fiscal year 1999 or any of the fiscal years 2000 through 2002, the Secretary, subject to subsection (d) of this section, shall reserve for the fiscal year involved, for making awards of grants and contracts under part B of this subchapter with respect to nurse practitioners and nurse midwives, not less than the percentage Section 297q (a) Authorization of appropriations For the purpose of carrying out parts B, C, and D of this subchapter (subject to section 297t (g) of this title), there are authorized to be appropriated $65,000,000 $338,000,000 for fiscal year , and such sums as may be necessary for each of the fiscal years through (b) Allocations for fiscal years 1998 through 2002 (1) Nurse practitioners; nurse midwives (A) Fiscal year 1998 Of the amount appropriated under subsection (a) of this section for fiscal year 1998, the Secretary shall reserve not less than $17,564,000 for making awards of grants and contracts under section 296m of this title as such section was in effect for fiscal year (B) Fiscal years 1999 through 2002 Of the amount appropriated under subsection (a) of this section for fiscal year 1999 or any of the fiscal years 2000 through 2002, the Secretary, subject to subsection (d) of this section, shall reserve for the fiscal year involved, for making awards of grants and contracts under part B of this subchapter $290 million represents the Nursing Community s request of $215 million for FY 2010 and an additional $85 million to support the Nurse Education, Expansion and Development Act (S. 497 and H.R. 2043), which is included as Recommendation 16 From , a funding methodology was applied to the Title VIII programs, which provided a specific percentage of funding for basic and advanced training. In 2003, after the Nurse Reinvestment Act, this methodology was no longer used for Title VIII. After 2003, the funds could be applied to the areas under Title VIII where they were most needed. 21

22 constituted by the ratio of the amount appropriated under section 296m of this title as such section was in effect for fiscal year 1998 to the total of the amounts appropriated under this subchapter for such fiscal year. For purposes of the preceding sentence, the Secretary, in determining the amount that has been reserved for the fiscal year involved, shall include any amounts appropriated under subsection (a) of this section for the fiscal year that are obligated by the Secretary to continue in effect grants or contracts under section 296m of this title as such section was in effect for fiscal year (2) Nurse anesthetists (A) Fiscal year 1998 Of the amount appropriated under subsection (a) of this section for fiscal year 1998, the Secretary shall reserve not less than $2,761,000 for making awards of grants and contracts under section of this title as such section was in effect for fiscal year (B) Fiscal years 1999 through 2002 Of the amount appropriated under subsection (a) of this section for fiscal year 1999 or any of the fiscal years 2000 through 2002, the Secretary, subject to subsection (d) of this section, shall reserve for the fiscal year involved, for making awards of grants and contracts under part B of this subchapter with respect to nurse anesthetists, not less than the percentage constituted by the ratio of the amount appropriated under section of this title as such section was in with respect to nurse practitioners and nurse midwives, not less than the percentage constituted by the ratio of the amount appropriated under section 296m of this title as such section was in effect for fiscal year 1998 to the total of the amounts appropriated under this subchapter for such fiscal year. For purposes of the preceding sentence, the Secretary, in determining the amount that has been reserved for the fiscal year involved, shall include any amounts appropriated under subsection (a) of this section for the fiscal year that are obligated by the Secretary to continue in effect grants or contracts under section 296m of this title as such section was in effect for fiscal year (2) Nurse anesthetists (A) Fiscal year 1998 Of the amount appropriated under subsection (a) of this section for fiscal year 1998, the Secretary shall reserve not less than $2,761,000 for making awards of grants and contracts under section of this title as such section was in effect for fiscal year (B) Fiscal years 1999 through 2002 Of the amount appropriated under subsection (a) of this section for fiscal year 1999 or any of the fiscal years 2000 through 2002, the Secretary, subject to subsection (d) of this section, shall reserve for the fiscal year involved, for making awards of grants and contracts under part B of this subchapter with respect to nurse anesthetists, not less than the percentage constituted by the ratio Due to the diverse avenues for individuals to become a nurse, as well as the number of nursing specialties at the advanced practice level, creating a funding methodology would limit the ability of Congress to directly apply funding to the Title VIII programs that require attention. 22

23 effect for fiscal year 1998 to the total of the amounts appropriated under this subchapter for such fiscal year. For purposes of the preceding sentence, the Secretary, in determining the amount that has been reserved for the fiscal year involved, shall include any amounts appropriated under subsection (a) of this section for the fiscal year that are obligated by the Secretary to continue in effect grants or contracts under section of this title as such section was in effect for fiscal year (c) Allocations after fiscal year 2002 (1) In general For fiscal year 2003 and subsequent fiscal years, amounts appropriated under subsection (a) of this section for the fiscal year involved shall be allocated by the Secretary among parts B, C, and D of this subchapter (and programs within such parts) according to a methodology that is developed in accordance with paragraph (2). The Secretary shall enter into a contract with a public or private entity for the purpose of developing the methodology. The contract shall require that the development of the methodology be completed not later than February 1, (2) Use of certain factors The contract under paragraph (1) shall provide that the methodology under such paragraph will be developed in accordance with the following: (A) The methodology will take into account the need for and the distribution of health of the amount appropriated under section of this title as such section was in effect for fiscal year 1998 to the total of the amounts appropriated under this subchapter for such fiscal year. For purposes of the preceding sentence, the Secretary, in determining the amount that has been reserved for the fiscal year involved, shall include any amounts appropriated under subsection (a) of this section for the fiscal year that are obligated by the Secretary to continue in effect grants or contracts under section of this title as such section was in effect for fiscal year (c) Allocations after fiscal year 2002 (1) In general For fiscal year 2003 and subsequent fiscal years, amounts appropriated under subsection (a) of this section for the fiscal year involved shall be allocated by the Secretary among parts B, C, and D of this subchapter (and programs within such parts) according to a methodology that is developed in accordance with paragraph (2). The Secretary shall enter into a contract with a public or private entity for the purpose of developing the methodology. The contract shall require that the development of the methodology be completed not later than February 1, (2) Use of certain factors The contract under paragraph (1) shall provide that the methodology under such paragraph will be developed in accordance with the following: 23

24 services among medically underserved populations, as determined according to the factors that apply under section 254b (b)(3) of this title. (B) The methodology will take into account the need for and the distribution of health services in health professional shortage areas, as determined according to the factors that apply under section 254e (b) of this title. (C) The methodology will take into account the need for and the distribution of mental health services among medically underserved populations and in health professional shortage areas. (D) The methodology will be developed in consultation with individuals in the field of nursing, including registered nurses, nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists, nursing educators and educational institutions, nurse executives, pediatric nurse associates and practitioners, and women s health, obstetric, and neonatal nurses. (E) The methodology will take into account the following factors with respect to the States: (i) A provider population ratio equivalent to a managed care formula of 1/1,500 for primary care services. (ii) The use of whole rather than fractional counts in determining the number of health care providers. (iii) The counting of only employed health care providers in determining the number of health care providers. (A) The methodology will take into account the need for and the distribution of health services among medically underserved populations, as determined according to the factors that apply under section 254b (b)(3) of this title. (B) The methodology will take into account the need for and the distribution of health services in health professional shortage areas, as determined according to the factors that apply under section 254e (b) of this title. (C) The methodology will take into account the need for and the distribution of mental health services among medically underserved populations and in health professional shortage areas. (D) The methodology will be developed in consultation with individuals in the field of nursing, including registered nurses, nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists, nursing educators and educational institutions, nurse executives, pediatric nurse associates and practitioners, and women s health, obstetric, and neonatal nurses. (E) The methodology will take into account the following factors with respect to the States: (i) A provider population ratio equivalent to a managed care formula of 1/1,500 for primary care services. (ii) The use of whole rather than fractional counts in determining the number of health care providers. (iii) The counting of only employed health 24

25 (iv) The number of families whose income is less than 200 percent of the official poverty line (as established by the Director of the Office of Management and Budget and revised by the Secretary in accordance with section 9902 (2) of this title). (v) The rate of infant mortality and the rate of low-birthweight births. (vi) The percentage of the general population constituted by individuals who are members of racial or ethnic minority groups, stated both by minority group and in the aggregate. (vii) The percentage of the general population constituted by individuals who are of Hispanic ethnicity. (viii) The number of individuals residing in health professional shortage areas, and the number of individuals who are members of medically underserved populations. (ix) The percentage of the general population constituted by elderly individuals. (x) The extent to which the populations served have a choice of providers. (xi) The impact of care on hospitalizations and emergency room use. (xii) The number of individuals who lack proficiency in speaking the English language. (xiii) Such additional factors as the Secretary determines to be appropriate. (3) Report to Congress Not later than 30 days after the completion of the development of the methodology required in paragraph (1), the Secretary shall submit to the Committee on Commerce of care providers in determining the number of health care providers. (iv) The number of families whose income is less than 200 percent of the official poverty line (as established by the Director of the Office of Management and Budget and revised by the Secretary in accordance with section 9902 (2) of this title). (v) The rate of infant mortality and the rate of low-birthweight births. (vi) The percentage of the general population constituted by individuals who are members of racial or ethnic minority groups, stated both by minority group and in the aggregate. (vii) The percentage of the general population constituted by individuals who are of Hispanic ethnicity. (viii) The number of individuals residing in health professional shortage areas, and the number of individuals who are members of medically underserved populations. (ix) The percentage of the general population constituted by elderly individuals. (x) The extent to which the populations served have a choice of providers. (xi) The impact of care on hospitalizations and emergency room use. (xii) The number of individuals who lack proficiency in speaking the English language. (xiii) Such additional factors as the Secretary determines to be appropriate. (3) Report to Congress Not later than 30 days after the completion of the development of the methodology 25

26 the House of Representatives, and to the Committee on Labor and Human Resources of the Senate, a report describing the methodology and explaining the effects of the methodology on the allocation among parts B, C, and D of this subchapter (and programs within such parts) of amounts appropriated under subsection (a) of this section for the first fiscal year for which the methodology will be in effect. Such explanation shall include a comparison of the allocation for such fiscal year with the allocation made under this section for the preceding fiscal year. (d) Use of methodology before fiscal year 2003 With respect to the fiscal years 1999 through 2002, if the report required in subsection (c)(3) of this section is submitted in accordance with such subsection not later than 90 days before the beginning of such a fiscal year, the Secretary may for such year implement the methodology described in the report (rather than implementing the methodology in fiscal year 2003), in which case subsection (b) of this section ceases to be in effect. The authority under the preceding sentence is subject to the condition that the fiscal year for which the methodology is implemented be the same fiscal year identified in such report as the fiscal year for which the methodology will first be in effect. (e) Authority for use of additional factors in methodology required in paragraph (1), the Secretary shall submit to the Committee on Commerce of the House of Representatives, and to the Committee on Labor and Human Resources of the Senate, a report describing the methodology and explaining the effects of the methodology on the allocation among parts B, C, and D of this subchapter (and programs within such parts) of amounts appropriated under subsection (a) of this section for the first fiscal year for which the methodology will be in effect. Such explanation shall include a comparison of the allocation for such fiscal year with the allocation made under this section for the preceding fiscal year. (d) Use of methodology before fiscal year 2003 With respect to the fiscal years 1999 through 2002, if the report required in subsection (c)(3) of this section is submitted in accordance with such subsection not later than 90 days before the beginning of such a fiscal year, the Secretary may for such year implement the methodology described in the report (rather than implementing the methodology in fiscal year 2003), in which case subsection (b) of this section ceases to be in effect. The authority under the preceding sentence is subject to the condition that the fiscal year for which the methodology is implemented be the same fiscal year identified in such report as the fiscal year for which the methodology will first be in effect. 26

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